Provider First Line Business Practice Location Address:
94 LAMPLIGHTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK HILL
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25901-0200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-465-5886
Provider Business Practice Location Address Fax Number:
304-469-9877
Provider Enumeration Date:
10/31/2006